Journal of anesthesia
-
Journal of anesthesia · Aug 2014
Where is the apex of the sacral hiatus for caudal epidural block in the pediatric population? A radio-anatomic study.
Caudal epidural block (CEB), administered through the sacral hiatus, is a regional anesthetic technique commonly used in children. To facilitate and optimize pediatric CEB, morphometric data that may be important for the sacral hiatus have been obtained using multidetector computed tomography (MDCT). ⋯ Dural puncture is inevitable for CEB applied at the S2 level. Consequently, CEB should be applied below this level (range, 1.36-2.17 cm) from the midpoint of the interspinous distance between the PSIS (at the same level with S2) in children aged 1-9 years.
-
Journal of anesthesia · Aug 2014
Case ReportsTreatment of life-threatening hypercapnia with isoflurane in an infant with status asthmaticus.
We encountered a 2-year-old child with life-threatening hypercapnia, with a PaCO(2) of 238 mm Hg and severe respiratory and metabolic acidosis, due to status asthmaticus that was refractory to steroid and bronchodilator therapy. Suspecting ventilatory failure and excessive ventilation-induced obstructive shock, we started respiratory physiotherapy in synchrony with her respiration, to facilitate exhalation from her over-inflated lungs. Isoflurane inhalation was commenced in preparation for extracorporeal circulation, to reduce the hypercapnia. ⋯ In our patient with a severe asthmatic attack, decreased exhalation secondary to asthma and overventilation during artificial ventilation resulted in overinflation of the lungs, which in turn led to cerebral edema and obstructive cardiac failure. The favorable outcome in this case was due to the short duration of hypercapnia. Hence, we conclude that the duration of hypercapnia is an important determinant of the morbidity and mortality of status asthmaticus-induced severe hypercapnia.
-
Journal of anesthesia · Aug 2014
Letter Case ReportsImprovement of NMDA encephalitis by active lymph node removal.
-
Journal of anesthesia · Aug 2014
Randomized Controlled TrialMethadone patient-controlled analgesia for postoperative pain: a randomized, controlled, double-blind study.
Postoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA. ⋯ This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA.
-
Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyAnalgesic efficacy and outcome of transversus-abdominis plane block versus low thoracic-epidural analgesia after laparotomy in ischemic heart disease patients.
Tranversus-abdominis plane (TAP) block is a novel technique alternative to central neural blockade in providing analgesia to the anterior abdominal wall. As such, we compared the analgesic efficacy of TAP block with low thoracic-epidural analgesia (TEA) in ischemic heart disease patients after abdominal laparotomy. ⋯ Low TEA reduced morphine consumption and provided a higher analgesic efficacy compared with TAP block after laparotomy in ischemic heart disease patients.